scholarly journals Surgical Approach to Rib Fractures

2021 ◽  
Author(s):  
Turkan Dubus
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Unit Stay ◽  
Surgical Approach ◽  
Flail Chest ◽  
Rib Fractures ◽  
Respiratory Problems ◽  
Chest Deformity ◽  
Intercostal Block

Rib fractures due to thorax trauma are one of the issues that mostly concern thoracic surgeons. Treatment for rib fractures is usually conservative. However, in some cases, fractured rib can cause complicated situations and surgical repair is required. Very serious respiratory problems occur in multiple costa fractures. Therefore, many advantages of surgical stabilization of the thorax wall have been reported. Especially shortening mechanical ventilation, decreasing the duration of intensive care unit stay, is important in preventing complications. Operation indications; Persistent pain despite intercostal block, narcotic and nonsteroidal anti-inflammatory analgesics, It was determined upon the presence of leakage from the thorax tube, intrathoracic hematoma and flail chest deformity. Nowadays, nithinol plates and titanium plates are frequently used in surgeon fixation of the rib fractures.

scholarly journals Intrathecal Immunoglobulin for treatment of adult patients with tetanus: A randomized controlled 2x2 factorial trial

2018 ◽  
Vol 3 ◽  
pp. 58
Author(s):  
Huỳnh Thị Loan ◽  
Lam Minh Yen ◽  
Evelyne Kestelyn: ◽  
Nguyen Van Hao ◽  
Tran Tan Thanh ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Nervous System ◽  
Intensive Care ◽  
Autonomic Nervous System ◽  
Intensive Care Unit Stay ◽  
Autonomic Nervous System Dysfunction ◽  
Tetanus Antitoxin ◽  
Randomized Controlled ◽  
Hospital Intensive Care Unit

Despite long-standing availability of an effective vaccine, tetanus remains a significant problem in many countries. Outcome depends on access to mechanical ventilation and intensive care facilities and in settings where these are limited, mortality remains high. Administration of tetanus antitoxin by the intramuscular route is recommended treatment for tetanus, but as the tetanus toxin acts within the central nervous system, it has been suggested that intrathecal administration of antitoxin may be beneficial. Previous studies have indicated benefit, but with the exception of one small trial no blinded studies have been performed. The objective of this study is to establish whether the addition of intrathecal tetanus antitoxin reduces the need for mechanical ventilation in patients with tetanus. Secondary objectives: to determine whether the addition of intrathecal tetanus antitoxin reduces autonomic nervous system dysfunction and length of hospital/ intensive care unit stay; whether the addition of intrathecal tetanus antitoxin in the treatment of tetanus is safe and cost-effective; to provide data to inform recommendation of human rather than equine antitoxin. This study will enroll adult patients (≥16 years old) with tetanus admitted to the Hospital for Tropical Diseases, Ho Chi Minh City. The study is a 2x2 factorial blinded randomized controlled trial. Eligible patients will be randomized in a 1:1:1:1 manner to the four treatment arms (intrathecal treatment and human intramuscular treatment, intrathecal treatment and equine intramuscular treatment, sham procedure and human intramuscular treatment, sham procedure and equine intramuscular treatment). Primary outcome measure will be requirement for mechanical ventilation. Secondary outcome measures: duration of hospital/ intensive care unit stay, duration of mechanical ventilation, in-hospital and 240-day mortality and disability, new antibiotic prescription, incidence of ventilator associated pneumonia and autonomic nervous system dysfunction, total dose of benzodiazepines and pipecuronium, and incidence of adverse events. Trial registration: ClinicalTrials.gov NCT02999815 Registration date: 21 December 2016

scholarly journals Tracheostomy in patients with SARS-CoV-2 reduces time on mechanical ventilation but not intensive care unit stay

2021 ◽  
Vol 42 (2) ◽  
pp. 102867
Author(s):  
Nieves Mata-Castro ◽  
Lorena Sanz-López ◽  
Paloma Pinacho-Martínez ◽  
David Varillas-Delgado ◽  
Miguel Miró-Murillo ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Intensive Care Unit Stay

scholarly journals Evaluation of risk factors affecting morbidity in patients who underwent surgical closure of ventricular septal defect

2021 ◽  
Author(s):  
Gokcen Ozcifci ◽  
Umut Altug ◽  
Fatih Durak ◽  
Ayse Anil ◽  
Pinar Kulluoglu ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Ventricular Septal Defect ◽  
Hospital Stay ◽  
Intensive Care Unit Stay ◽  
Pediatric Intensive Care Unit ◽  
Septal Defect ◽  
Pediatric Intensive Care ◽  
Surgical Closure

Objective: Surgical closure of ventricular septal defect is still the most common pediatric cardiac surgical procedure. The aim of this study was to define the risk factors of the complications of ventricular septal defect surgery. Methods: We evaluated the preoperative, perioperative, and postoperative data from echocardiography reports, perfusion reports, and clinical, inpatient, and operative notes of all the patients. The following were the outcome variables for this study: in-hospital death; duration of mechanical ventilation in hours; duration of pediatric intensive care unit stay in days; and duration of hospital stay in days. Herein, we report our single pediatric cardiac center experience between October 2015 and October 2018. Results: A total of 108 patients underwent surgical ventricular septal defect closure during the study period. Prolonged pediatric intensive care unit stay, hospital stay and mechanical ventilation time was associated with younger age and low weight. The patients with genetic syndromes had statistically longer mechanical ventilation time (p < 0.001), pediatric intensive care unit stay (p < 0.001), and hospital stay (p = 0.002). Conclusion: Although genetic syndromes did not affect the complication rates, it affected the lengths of hospital and pediatric intensive care unit stays and mechanical ventilation duration. Young age and lower body weight was a risk factor of prolonged hospitalization, prolonged pediatric intensive care unit stay and prolonged mechanical ventilation. Therefore, these situations should be considered in the postoperative follow-up of patients with ventricular septal defect.

scholarly journals Intrathecal Immunoglobulin for treatment of adult patients with tetanus: A randomized controlled 2x2 factorial trial

2018 ◽  
Vol 3 ◽  
pp. 58 ◽  
Author(s):  
Huỳnh Thị Loan ◽  
Lam Minh Yen ◽  
Evelyne Kestelyn: ◽  
Nguyen Van Hao ◽  
Tran Tan Thanh ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Nervous System ◽  
Intensive Care ◽  
Autonomic Nervous System ◽  
Intensive Care Unit Stay ◽  
Autonomic Nervous System Dysfunction ◽  
Tetanus Antitoxin ◽  
Randomized Controlled ◽  
Hospital Intensive Care Unit

Despite long-standing availability of an effective vaccine, tetanus remains a significant problem in many countries. Outcome depends on access to mechanical ventilation and intensive care facilities and in settings where these are limited, mortality remains high. Administration of tetanus antitoxin by the intramuscular route is recommended treatment for tetanus, but as the tetanus toxin acts within the central nervous system, it has been suggested that intrathecal administration of antitoxin may be beneficial. Previous studies have indicated benefit, but with the exception of one small trial no blinded studies have been performed. The objective of this study is to establish whether the addition of intrathecal tetanus antitoxin reduces the need for mechanical ventilation in patients with tetanus. Secondary objectives: to determine whether the addition of intrathecal tetanus antitoxin reduces autonomic nervous system dysfunction and length of hospital/ intensive care unit stay; whether the addition of intrathecal tetanus antitoxin in the treatment of tetanus is safe and cost-effective; to provide data to inform recommendation of human rather than equine antitoxin. This study will enroll adult patients (≥16 years old) with tetanus admitted to the Hospital for Tropical Diseases, Ho Chi Minh City. The study is a 2x2 factorial blinded randomized controlled trial. Eligible patients will be randomized in a 1:1:1:1 manner to the four treatment arms (intrathecal treatment and human intramuscular treatment, intrathecal treatment and equine intramuscular treatment, sham procedure and human intramuscular treatment, sham procedure and equine intramuscular treatment). Primary outcome measure will be requirement for mechanical ventilation. Secondary outcome measures: duration of hospital/ intensive care unit stay, duration of mechanical ventilation, in-hospital and 240-day mortality and disability, new antibiotic prescription, incidence of ventilator associated pneumonia and autonomic nervous system dysfunction, total dose of benzodiazepines and pipecuronium, and incidence of adverse events. Trial registration: ClinicalTrials.gov NCT02999815 Registration date: 21 December 2016

scholarly journals The Effect of Dexmedetomidine as a Sedative Agent for Mechanically Ventilated Patients With Sepsis: A Systematic Review and Meta-Analysis

2021 ◽  
Vol 8 ◽  
Author(s):  
Caimu Wang ◽  
Qijiang Chen ◽  
Ping Wang ◽  
Weisheng Jin ◽  
Chao Zhong ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Mechanical Ventilation ◽  
Intensive Care ◽  
Inflammatory Response ◽  
Intensive Care Unit Stay ◽  
Meta Analysis ◽  
Mechanically Ventilated ◽  
Mechanically Ventilated Patients ◽  
Ventilated Patients ◽  
Sedative Agents

Purpose: Dexmedetomidine has been shown to improve clinical outcomes in critically ill patients. However, its effect on septic patients remains controversial. Therefore, the purpose of this meta-analysis was to assess the effect of dexmedetomidine as a sedative agent for mechanically ventilated patients with sepsis.Methods: We searched PubMed, Embase, Scopus, and Cochrane Library from inception through May 2021 for randomized controlled trials that enrolled mechanically ventilated, adult septic patients comparing dexmedetomidine with other sedatives or placebo.Results: A total of nine studies involving 1,134 patients were included in our meta-analysis. The overall mortality (RR 0.97, 95%CI 0.82 to 1.13, P = 0.67, I2 = 25%), length of intensive care unit stay (MD −1.12, 95%CI −2.89 to 0.64, P = 0.21, I2 = 71%), incidence of delirium (RR 0.95, 95%CI 0.72 to 1.25, P = 0.70, I2 = 0%), and delirium free days (MD 1.76, 95%CI –0.94 to 4.47, P = 0.20, I2 = 80%) were not significantly different between dexmedetomidine and other sedative agents. Alternatively, the use of dexmedetomidine was associated with a significant reduction in the duration of mechanical ventilation (MD –0.53, 95%CI −0.85 to −0.21, P = 0.001, I2 = 0%) and inflammatory response (TNF-α: MD −5.27, 95%CI −7.99 to −2.54, P&lt;0.001, I2 = 0%; IL-1β: MD −1.25, 95%CI −1.91 to –0.59, P&lt;0.001, I2 = 0%).Conclusions: For patients with sepsis, the use of dexmedetomidine as compared with other sedative agents does not affect all-cause mortality, length of intensive care unit stay, the incidence of delirium, and delirium-free days. But the dexmedetomidine was associated with the reduced duration of mechanical ventilation and inflammatory response.

Sign in / Sign up

Export Citation Format

Share Document